Launching of Anatomical Pathology Service Project in Eritrea

Eritreans residing in Australia have introduced an Anatomical Pathology service project in Eritrea through a training program. The project aims to improve Surgical Pathology (Histo- and Cytopathology) services of Eritrean Hospitals and provide high quality patient care by incorporating modern systems of reporting using the Whole Slide Imaging (WSI) in Eritrean laboratory and remote access and reporting of Pathology cases by Australian Pathologists.

Fundamentally, Surgical Pathology is concerned with the treatment plan of a patient by taking a sample of body tissues(specimen) for diagnostic or forensic purpose. The sample tissue and cells are taken out by a surgical procedure (histopathology) or by fine needle aspiration (cytopathology). It is estimated that 60–70% of all diagnosis depends on pathology, including the early detection and diagnosis of cancer.

Developing nations often lack the resources and medical personnel necessary to provide patients with accurate and prompt diagnosis for an appropriate treatment. This shortage of trained pathologists and well- equipped laboratories has created massive disparities in health outcomes between nations. Lack of trained Pathologists has been the main obstacle of efforts to develop modern surgical pathology practices in developing countries. However, modern technologies such as WSI, a process of digitizing glass Histo-and Cytopathology slides, and the creation of digitalized images have enabled Pathologists to examine the pathology specimens remotely.

To make this medical service practical in Eritrea, a special training has been given for the last one month to Eritrean laboratory technicians at the National Laboratory in Asmara. Mr. Dawit Sibahtu, a medical scientist, has been in Asmara to assess the National Laboratory and give training of Anatomical Pathology with the same protocols used in Australia. When the project becomes operational, it is expected to provide results a patient needs to know about the kind of cancer he/she has and its level within just five days. The cancer diagnosis will be carried out in a networked system through the newly installed slide scanner. Mr Dawit said that Professor Benhur Amanuel along with Eritrean fellows and Australian Pathologists initially launched the project of remote screening in the Anatomical Laboratory in Perth, west Australia and is currently closely directing it for its success. Upon submission by the Professor, the project proposal was approved by the Medical School of Orotta and has officially been going for a month.

Three stages of the Anatomical Pathology Service have been implemented so far. The first stage of the project aimed at establishing interconnection of the National Health Laboratory in Asmara and the Anatomical Laboratory in Perth, Australia as well as making an assessment of the local laboratory and the availability of Pathologists through an Australian pathologists’ representative. The second stage was to make the slide scanner machine available and operational in the laboratory that is later funded ($129,825) by the World Health Organization (WHO). Laboratory technicians are being familiarized with the scanner and how to send results for further diagnosis to Australia. The overall aim is to give a patient an accurate and quick result within few days. This is carried out with an online teleconference of pathologists that details a patient’s medical records after doing surgery. Later, the results brought from the Anatomical Laboratory in Australia are directly e-mailed to a surgeon in Eritrea who can easily prescribe treatment methods to the patient in need. The third stage of the ongoing project aims to spread the Anatomical Pathology Service in all referral hospitals in Eritrea instead of keeping one laboratory busy with specimens from all over the country.

sending of the specimen through the slide scanner

The outcome of the Anatomical Pathology Service project will be measured by the turnaround time of a patient and its accessibility throughout the country. That is the ultimate target. The turnaround time is the time between the surgery and diagnosis. According to the project plan, it takes only five days only for a patient to know the type and level of cancer he/she is diagnosed with. The other benefit citizens will enjoy in the future, with the success of the project, is the accessibility of the Anatomical Pathology service that will be easily offered in their nearest referral hospital. Further, the project aims to give consultation service by the overseas pathologists to local surgeons to enable them provide patients with the needed treatments. The interconnection of the National laboratory with the Australian Anatomical laboratory is mainly concerned about the due care a pathologist should give in order to pass the right information to surgeons in medical operation and, hence, avoid medical failures. The long term plan of the project is aimed at assisting a surgeon who faces unprecedented scenarios in the body of a patient. At such moments a surgeon is advised to send a sample of the body part to a pathologist who in turn checks the severity of the specimen and communicates with the surgeon to decide to cut off the part or leave it as it is. This scientific method of diagnosis prevents patients from suffering from unwanted surgeries.

Mr. Dawit believes that when the project becomes operational, it will ease the work of surgeons by helping them identify the type of cancer. The most commonly known types of cancers in Eritrea are breast cancer, squamous cell and Adenocarcinoma (Endometrial or Uterine cancers) in women and colon and prostate cancers in men. The National Laboratory in Asmara annually receives around 2000 specimens from all over the country. But lack of specialists, pathologists and modern machine has been prevented identification of cancer types patients have been suffering from. From now onwards, the National laboratory will be assisted by its qualified laboratory technicians and a modern slide scanner that can process up to 2500 specimens/ slides annually. This will bring a relief to everyone involved in cancer treatment in the country.

Mr. Kibrom Hailu, a histo-technologist and head of the Histopathology Department in Orotta, is one of the trainees participating in the project. Mr. Kibrom said that the training will be very helpful in doing a complete technical work at the laboratory and in sending information to surgeons at the right time with the assistance of the slide scanner. He further said that success of the project will make it possible for people to get treated in their home country and avoid extra medical costs they would have incurred by seeking treatment abroad.

The laboratory center located in Perth has also donated 28 microscopes to the College of Agriculture in Hamelmalo that are greatly helping the students learn more effectively.

Mr. Kibrom Hailu

According to the Medical Scientist, Mr. Dawit Sibahtu, the long term plan of the project is to involve pathologists in histopathology and special field of immunohistochemistry, an analytical process concerned with the identification of cancer staging and grading that would help in the direct treatment of a cancer patient. Basically introducing the pathology service in all referral hospitals of Eritrea is a priority. The aim of the project is to enhance the efficiency, timeliness, convenience, safety and quality of Pathology diagnosis by minimizing turnaround time for reports and by optimizing the use of the available workforce at minimal or no cost to the Eritrean health system.

Mr. Dawit said that wherever they are located Eritreans are the ambassadors of their country, and the willingness of the team to initiate this project is the intention to serve their country and its people with what they have learned. He advised that other citizens wherever their location in the world, should offer the same medical procedures of pathology in order to minimize cancer and cancer-related diseases affecting fellow citizens.

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Launching of Anatomical Pathology Service Project in Eritrea
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